急性非等容血液稀释联合控制性降压术对血液流变学和血浆蛋白的影响

Effects of acute non-isovolemic hemodilution combined with controlled hypotension on haemorheology and plasma protein

目的探讨急性非等容血液稀释(ANIH)联合控制性降压术(CH)对血液流变特性和血浆蛋白的影响。方法选择脊柱手术患者18例,术前采集15%～20%的血液后,补充2倍采血量的晶胶混合液行ANIH,以异氟醚或硝普钠行CH,维持平均动脉压(MAP)55～65mmHg(1mmHg=0.133kPa)。比较血液流变学、血浆蛋白、血浆渗透压(Posm)和乳酸(LA)的变化。结果(1)采血量(885.7±177.3)ml,出血量(2230.5±1451.2)ml,异体输血量(746.3±248.7)ml。(2)稀释后Hb和Hct均降低(P<0.01)。(3)全血黏度、红细胞聚集指数稀释后降低和红细胞变形指数增加均有统计学意义(P均<0.05)。(4)稀释后血浆蛋白显著降低(P<0.01),LA及Posm无明显变化。结论ANIH+CH对Posm无明显影响,循环功能稳定,血液流变特性优化,利于微循环灌注。ANIH+CH是一种有效的血液保护措施。

Objective To evaluate the effects of acute non-isovolemic hemodilution （ANIH） combined with controlled hypotension （CH） on haemorheology and plasma protein. Methods Eighteen random selected operation cases with vertebral diseases, 15%-20% of the whole blood volume were taken before the operation, then twice of the volume of the mixing solution were infused within 30 minutes to get ANIH. CH was induced by isoflurane inhalation or by sodium nitroprusside and MAP was reduced to 55-65 mm Hg （ 1 mm Hg=0.133 kPa）. The variances of haemorheology variables, plasma protein, plasma osmotic pressure and lactic acid were compared. Results （1） The volume of haemospasia（885.7 ± 177.3）ml, blood losing（2230.5 ± 1451.2）ml,xenogenic blood transfusion（746.3 ± 248.7）ml. （2） Both Hb and Hct decreased after diluted （P 〈 0.01）. （3） Whole blood viscosity, index numbers of erythrocyte aggregation were decreased after diluted, and index number of RBC deformation increased all had significant difference （P 〈 0.05）. （4） The plasma protein were all significant decreased after diluted （P 〈 0.01）, the plasma osmotic pressure and lactic acid had no significant change. Conclusions ANIH combined with CH can stabilize the circula- tion, improve the haemorheology, and fine the microcireulation perfusion, but has no obvious effectiveness to plasma osmotic pressure. ANIH combined with CH can serve as an effectively clinical blood protection means.